Kliniken Maria Hilf

The S2K guideline, organized by the German Respiratory Society, is aimed at physicians in Germany, Switzerland, and Austria who perform outpatient or inpatient diagnostic flexible bronchoscopy in adult patients. Its goal is to standardize the procedure, minimize complications, and improve diagnostic safety. The guideline specifically addresses specialists in pulmonology, thoracic surgery, and hospital hygiene, as well as nursing and technical staff. It provides evidence- and consensus-based recommendations on indications, preparation, execution, hygiene measures, and aftercare. Additionally, it serves as an information resource for physicians from other specialties, payers, professional societies, and can support quality management. It applies to medical care in Germany, Austria, and Switzerland and incorporates the latest scientific findings up to the date of publication.

Hintergrund und FragestellungDie Behandlung von Patienten mit Stadium-III-NSCLC (Non-Small Cell Lung Cancer) und T4-und/oder N2-N3-Beteiligung stellt eine groe therapeutische Herausforderung dar.Whrend fr resektable Tumorstadien durch Studien wie CheckMate-816, KEYNOTE-671 und AEGEAN die neoadjuvante bzw.perioperative Chemoimmuntherapie als neuer Behandlungsstandard etabliert wurde, blieb fr die Subgruppe der borderline-resektablen oder unresektablen T4/N2-N3-Tumoren ein bisheriger Paradigmenwechsel aus.Den aktuellen Therapiestandard bei dieser Subgruppe bildet die (simultane) Radiochemotherapie und im Falle einer Eignung die PA-CIFIC-analoge Durvalumaberhaltungstherapie.Jedoch war auch bei dieser Studie die Kohorte mit T4-und/oder N2-N3-Beteiligung unterreprsentiert [1].Eine aktuelle EORTC-Umfrage (Januar 2025) besttigte

ABSTRACTBackgroundBotulinum neurotoxin A (BoNT‐A) is recommended for the treatment of cervical dystonia (CD), spasticity, and blepharospasm. Some patients treated with BoNT‐A have been reported to develop neutralizing antibodies (NAbs) against BoNT‐A, which may result in reduced efficacy and, in some cases, secondary treatment failure (STF). Our aim was to investigate the incidence of STF and NAb positivity after treatment with one of three commercially‐available BoNT‐A formulations.MethodsA systematic review and meta‐analysis of STF and/or NAb positivity after treatment with abobotulinumtoxinA, incobotulinumtoxinA, or onabotulinumtoxinA in patients with CD, spasticity, or blepharospasm was conducted using PubMed, Embase, and Google Scholar.ResultsTwenty‐nine unique studies reported in 29 publications assessed NAb positivity and were included. The meta‐analysis showed that the proportions of patients developing STF were significantly higher after treatment with abobotulinumtoxinA or onabotulinumtoxinA than with incobotulinumtoxinA for CD or spasticity. Depending on the antibody test used, the proportions of patients developing NAbs were also significantly higher after treatment with abobotulinumtoxinA or onabotulinumtoxinA than with incobotulinumtoxinA for CD or spasticity. When data for all indications were pooled, proportions of NAb‐positive patients were numerically higher with increasing mean doses of abobotulinumtoxinA or onabotulinumtoxinA. No patients treated exclusively with incobotulinumtoxinA were found to have developed immunogenic STF or persistent NAbs.ConclusionsThe risk of developing STF and NAbs appears to vary with indication and BoNT‐A formulation. When the efficacy and safety of formulations are comparable, incobotulinumtoxinA may be recommended to avoid developing STF and immunogenicity, particularly for patients requiring higher doses and repeated treatments.

Aprolonged overall treatment time (OTT) has been demonstrated to adversely affect the primary radiation therapy (RT) outcome in various solid tumors, including non-small cell lung cancer (NSCLC). Retrospective data from our group suggested an advantage of shorter OTT also for postoperative RT (PORT) in patients with NSCLC. The PORTAF trial (ClinicalTrials.gov: NCT02189967) was initiated to prospectively test this hypothesis. The multicenter prospective randomized phaseII trial in patients with NSCLC investigated whether an accelerated schedule of PORT (7fractions per week, 2 Gy per fraction, OTT 3.5-4weeks) improved outcome compared to conventional fractionation (5fractions per week, 2 Gy per fraction, OTT 5-6weeks). Target volumes and total radiation doses were stratified in both treatment arms based on individual risk factors. Primary endpoint of the study was locoregional tumor control (LRTC) 36months after PORT, with 154 patients to be included in each arm. Due to slow accrual and changed indications for PORT, we prematurely closed the trial in 2019. Between 2014 and 2019, eight recruiting centers included 27evaluable patients. An interim safety analysis performed for the first 21patients showed nonsignificant differences regarding grade3 toxicities between the treatment arms, thus not meeting the termination criteria. LRTC was not significantly different between accelerated (73%) and conventionally fractionated RT (92%; p = 0.535). Noteworthily, in 21FDG-PET/CT restagings before RT, an unexpectedly high number of locoregional recurrences (n = 4) and distant metastases (n = 2) were seen, resulting in changed treatment intentions for these patients. The prematurely closed PORTAF trial did not find significant differences in 3‑year LRTC when comparing accelerated versus conventionally fractionated irradiation. The observed additional benefit of FDG-PET/CT restaging prior to PORT should be further investigated in alarger cohort to optimize patient selection and avoid unnecessary side-effects.

Rectal cancer disproportionately affects the elderly population, with more than half of cases diagnosed in individuals aged 70years or older. Frail patients in this group often face significant challenges tolerating the standard treatment of total mesorectal excision (TME), due to elevated risks of surgical complications and perioperative morbidity. Advances in radiotherapy techniques offer a viable alternative, providing effective tumor control while minimizing treatment-related toxicity. Recent clinical trials, including OPERA and MORPEUS, have demonstrated that dose-escalated radiotherapy, which integrates external beam (chemo)radiotherapy (EBRT) with high-dose-rate endorectal brachytherapy (HDR-BT) or contact X-ray brachytherapy (CXB), can achieve high clinical response rates and facilitate organ preservation in younger, healthier patient cohorts. Building on these findings, the ACO/ARO/AIO-22 study seeks to adapt these innovative approaches to meet the needs of elderly and frail patients with rectal cancer. The ACO/ARO/AIO-22 trial is a prospective multicentre controlled trial. Elderly (age ≥70years) and/or frail patients with non-metastatic rectal adenocarcinoma (cT1-3d N0/+ M0, mrCRM - / +) localized 0-16cm from the ano-cutaneous line, unable to undergo radical surgery can be included. The initial treatment comprises an external beam radiation (EBRT) regime with 13×3Gy (total: 39Gy) over a period of two and a half weeks. Following initial restaging 6.5weeks after completion of EBRT, endorectal HDR-BT will be delivered with 3 weekly fractions of 8Gy to a total dose of 24Gy (prescribed at the radial margin of the tumor; with a maximum prescription depth of 10mm); alternatively, with CXB with 90Gy in 3 weekly fractions. The primary objective is complete or near complete clinical response (cCR or ncCR) and the second primary endpoint is quality of life (QoL) measured with the EORTC QLQ-ELD14, both at 12months after treatment start. The ACO/ARO/AIO-22 prospective multicentre trial will evaluate organ preservation rates and QoL after combining EBRT with endorectal HDR-BT in elderly and/or frail patients with rectal cancer.Trial Registration:Clinicialtrials.gov number: NCT06729645.

2038 Background: The HIPPORAD trial aimed to evaluate a new method of whole brain radiation therapy (WBRT) with simultaneous integrated boost (SIB) to the metastases, with versus without hippocampal avoidance in patients with brain metastases. Methods: We conducted a prospective, multicentre, randomised, double-blind trial (DRKS00004598). Patients with 4-10 brain metastases > = 5mm were randomised at 13 centres in Germany 1:1 between WBRT+SIB with hippocampus avoidance (HA-WBRT+SIB) (arm A) and WBRT+SIB (arm B). Patients and assessors of outcome were blinded to the randomised arm. All patients received WBRT with 30 Gy and SIB with 51 Gy or 42 Gy in 12 fractions, 5x/week. The primary endpoint was the change in neurocognitive function (assessed by the Verbal Learning and Memory Test [VLMT]) 3 months after treatment. Secondary endpoints included neurocognitive changes at 9 and 18 months, development of anxiety and depression, quality of life and measures of oncological outcome. Results: Between August 2 nd , 2016 and September 7 th , 2021, 170 patients were recruited and 136 were randomised between HA-WBRT+SIB (n = 67) and WBRT+SIB (n = 69). Of these, 38 patients in arm A and 42 in arm B were known to be alive 3 months after treatment and were included in the primary endpoint analysis. The change in overall learning performance at 3 months was not significantly different between arms (p = 0.83). VLMT-scores decreased after 3 months, but improved at 9 and 18 months, with HA-WBRT+SIB showing an overall superior trend over WBRT+SIB. At 18 months, VLMT-scores improved to values above baseline in both arms. Patients treated with HA-WBRT+SIB had significantly less depression compared to patients treated with WBRT+SIB at 3 (p = 0.047) and 18 months (p = 0.048). The 12-month-tumor control for boosted metastases was 96% in Arm A and 88% in Arm B, while for the WBRT area it was 78% in both arms. Time to hippocampal tumour progression was comparable between arms (p = 0.98). After 12 months, 4% of patients in arm A and 12% in arm B had suffered neurological death. Conclusions: To our knowledge, this is the first prospective trial to show that hippocampal avoidance during WBRT leads to significantly lower rates of depression. The development of VLMT values after HA-WBRT+SIB and WBRT+SIB with 30 Gy in 2.5 Gy-fractions was comparable and a good recovery was observed at 18 months in both arms. The method showed a considerably higher intracerebral tumour control with lower neurological mortality rates compared to historical cohorts. Clinical trial information: DRKS00004598 .